1306196738 NPI number — DR. JESSICA MARIE HUSSAR BOYLE PSYD

Table of content: DR. JESSICA MARIE HUSSAR BOYLE PSYD (NPI 1306196738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306196738 NPI number — DR. JESSICA MARIE HUSSAR BOYLE PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSSAR BOYLE
Provider First Name:
JESSICA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUSSAR
Provider Other First Name:
JESSICA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306196738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 HICKORY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13905-1347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-252-6634
Provider Business Practice Location Address Fax Number:
607-203-5720
Provider Enumeration Date:
09/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  023416 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TS0200X , with the licence number: 993174151 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023416 . This is a "PSYCHOLOGIST LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41401 . This is a "NCSP CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 993174151 . This is a "SCHOOL PSYCHOLOGIST STATE CERTIFICATION CONTROL NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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